Device for use during medical procedures

ABSTRACT

An instrument table for placement on an operating table on which a patient rests during a medical procedure includes a planar portion having a top surface and a bottom surface, the planar portion having a width less than the width of the operating table, at least one support coupled to the bottom surface of the planar portion for supporting the instrument table on the operating table, and a radiation shield, coupled to at least one of the planar portion and the at least one support.

RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.10/830,949 filed on Apr. 22, 2004 and entitled, “Device for Use DuringMedical Procedures,” which is herein incorporated by reference.

FIELD OF THE INVENTION

Embodiments of the present invention are directed to medicalinstrumentation, and more particularly to an instrument table andradiation protection device for use during medical procedures.

BACKGROUND OF THE INVENTION

Minimally invasive endovascular procedures have been developed to treatvascular diseases, such as blockage of the arteries. Some vascularblockages can be corrected by employing radiologic treatments thatalleviate the need for invasive surgeries. Patients undergoingradiologic endovascular procedures are often awake, and therefore freeto move around during the procedure. This creates concerns for theprovider of the procedure. For example, the provider must carefullyplace his/her instruments in a convenient and easily accessible locationwhile avoiding placement of the instruments in a location where thepatient may disturb the instruments or be injured by the instruments.

During a radiologic procedure, the provider is also concerned withprolonged exposure to radiation, which can be highly harmful. Forexample, a provider may perform more than one radiology procedure eachday, causing him/her to be exposed for a duration that is harmful. Also,procedures performed on the heart, hips and/or thighs typically takelonger to complete, resulting in an increase of x-ray scatter, andtherefore increased exposure. Typically, providers wear lead aprons forprotection and not infrequently, providers also clip a meter tothemselves that can alert them to overexposure conditions.

SUMMARY OF THE INVENTION

It is desirable to provide a convenient and safe location forinstrumentation needed during a medical procedure, particularly forprocedures in which the patient may move around. It is further desirableto provide a radiation shield for medical providers to use duringprocedures requiring radiologic treatment.

The invention provides an apparatus and methods for protecting against aprovider's prolonged exposure to radiation during a medical procedure,while also providing a surface that increases efficient progression of amedical procedure without agitating the patient. An instrument tableincluding side mounted radiation exposure shields is placed over thelower legs of a patient undergoing an upper body procedure, such as acardiac or radiologic endovascular procedure. The instrument tableprovides a level surface onto which instruments are placed so that theinstruments are conveniently accessible to the physician. Side mountedradiation pads provide protection from x-ray scatter. Throughout theprocedure, the physician can be in close proximity to the patientundergoing radiologic treatment while not being concerned withoverexposure from x-ray scatter.

In one embodiment, the invention provides an instrument table forplacement on an operating table on which a patient rests during amedical procedure. The instrument table includes a planar portion havinga top surface and a bottom surface, the planar portion having a widthless than the width of the operating table, a first member coupled tothe bottom surface of the planar portion and substantially perpendicularto the planar portion, the first member comprising an inner panelconfigured to provide support to the planar portion and an outer panelmovable from a first position proximal to the inner panel and a secondposition distal from the inner panel. The inner panel and the outerpanel provide a radiation shield.

The invention may include one or more of the following features. Theplanar portion can be extendable in length. The outer panel may comprisea first radiation pad coupled to the inner panel. The outer panel can beconfigured to fold out to the second position distal from the innerpanel from an attachment point at an edge of the inner layer. The outerpanel can be extendable to a length greater than a length of the topsurface of the planar portion. The outer panel can be substantiallylonger (e.g., 1.5 times, twice, thrice, or more) relative to the lengthof the top surface of the planar portion. The outer panel can beremovably attached to the inner panel. The outer panel may extend belowa surface of the operating table. The first member can be constructedand arranged to allow clearance beneath the planar portion for humanlegs to rest without contacting an underside of the planar portion. Theinstrument table can include a second member coupled to the bottom ofthe planar portion on a side opposite the first member. The first sidesupport and the second side support may extend substantiallyperpendicularly from the planar portion to rest on the operating tablestraddling a portion of the legs of a patient resting on the operatingtable.

In a further embodiment, the invention provides an instrument table forplacement on an operating table on which a patient rests during amedical procedure. The table provides a planar portion having a topsurface and a bottom surface, the planar portion having a width lessthan the width of the operating table, at least one support coupled tothe bottom surface of the planar portion for supporting the instrumenttable on the operating table, and a radiation shield, coupled to atleast one of the planar portion and the at least one support.

The invention may include one or more of the following features. Theinstrument table includes a planar portion that is extendable in length.The planar portion includes an extendable portion on a topside of theinstrument table that pulls out to an extended length over the patient.Alternatively, the extendable portion is sandwiched between two planarlayers and is pulled out to extend the length of the instrument table.The height of the instrument table is also extendable or retractable byextending or retracting the at least one support. The at least onesupport is constructed and arranged to allow clearance beneath theplanar portion for legs of the subject (e.g., a human patient ornon-human animal subject, such as a dog, a cat, a horse, etc.) to restwithout contacting an underside of the planar portion, or with minimalcontact with the underside of the planar portion of the table. The atleast one support extends from a center of the planar portion such thata leg of the patient rests on each side of the at least one support. Theat least one support may alternatively comprise a first side support anda second side support. The first side support and the second sidesupport extend substantially perpendicularly from the planar portion torest on the operating table straddling a portion of the legs of apatient resting on the operating table. Thus, in a first embodiment, thelegs of the patient straddle the single table support, and in a secondembodiment, the first side support and the second side support straddlethe legs, collectively, of the patient.

The radiation shield comprises a first radiation pad coupled to a firstside of the planar portion and a second radiation pad coupled to asecond side of the planar portion. The first radiation pad and thesecond radiation pad are removably attached to the planar portion. Theradiation shield extends below a surface of the operating table.

Accordingly, in one aspect, the invention features an instrument tablehaving a horizontal surface, a right side support, and a left sidesupport. The supports are positioned a distance from one another suchthat the supports straddle the legs of a patient lying on an operatingtable in position for a procedure. In particular, the instrument tablestraddles the lower portion of the legs of a patient, such as below theknee, so that procedure can be performed on an upper leg and upper bodyportion. The width of the instrument table is wider than the width oftwo human legs (or two appendages of a non-human animal) lyingside-by-side and less wide than the width of a standard operating tableon which a patient lies, which is about two feet in width. Theinstrument table sits substantially horizontally on an operating tablewithout becoming unsteady due to movements by the patient.Alternatively, the instrument table rests on or contacts a portion ofthe legs of the patient. The instrument table has a height slightlygreater than the thickness of a human leg (or a non-human animalappendage) from a front side to a dorsal side. The height of theinstrument table is no lower than the height of the hip of the providerand no higher than the elbow height of the provider. Such a heightallows for convenient access to instrumentation on the instrument table.The instrument table is made of a rigid plastic or of a heavyfiberboard. The instrument table is alternatively constructed of metal,other plastics, and other known materials. The instrument table is madeof a radiation shielding material, for example.

Radiation pads are attached on the right side and the left side of theinstrument table. The radiation pads extend from the top horizontalplane of the instrument table and extend to the top horizontal plane ofthe surgery table. Alternatively, the radiation pads hang below thehorizontal planar portion of the operating table. The radiation pads areremovably attached to the instrument table using any of a number ofknown attaching devices, such as snaps, VELCRO, tape, and zippers.Radiation pads can be longer than the length of the instrument tablesuch that the radiation pads extend to a position over the upper legsand/or torso of the patient.

The invention will be more fully understood after a review of thefollowing figures, detailed description and claims.

BRIEF DESCRIPTION OF THE FIGURES

For a better understanding of the present invention, reference is madeto the figures which are incorporated herein by reference and in which:

FIG. 1A is a top view of an instrument table having side supports in oneembodiment of the invention;

FIG. 1B is a side perspective view of the instrument table of FIG. 1A;

FIG. 1C is a side perspective view of the bottom side of the instrumenttable of FIG. 1A;

FIG. 1D is a side perspective view of an extended instrument table inone embodiment of the invention;

FIGS. 2A-2B are views of the instrument table of FIG. 1A shown in useover the legs of a patient;

FIG. 3A is a perspective view of the prior art use of an operatingtable;

FIG. 3B is a perspective view of the instrument table of FIG. 1A in use;

FIG. 4 is a perspective view of the instrument table of FIG. 1A in use;

FIG. 5 is a schematic view of an instrument table laid out flat;

FIG. 6A is a perspective view of an instrument table in use;

FIG. 6B is a perspective view of a portion of the instrument table beingextended for use; and

FIG. 6C is a perspective view of an extendable portion of the instrumenttable in use.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides an instrument table for use during medicalprocedures performed on the upper body, including radiologicendovascular procedures. The invention provides radiation protection forthe provider of the medical procedure. In one aspect, the inventionprovides an instrument table having a support, the support beingpositioned such that the table rests steadily on an operating or surgerytable, the instrument table further having radiation pads on sideportions to decrease radiation exposure. Embodiments of the inventioncan be used without the radiation pads and for medical procedures otherthan radiologic endovascular procedures. Still further embodiments arewithin the scope of the invention.

Referring to FIGS. 1A-1C, a medical instrumentation table, or a “labslab” is shown. The lab slab 10 includes a top planar portion 20, aright side support 30, and a left side support 40. The right sidesupport 30 extends substantially perpendicularly from a bottom rightside 22 of the top portion. The left side support extends substantiallyperpendicularly from a bottom left side 24 of the top portion. The leftand right side supports are the length of the top portion and areequivalent to one another in height. The lab slab is designed to rest ona planar surface, such as an operating table, for use during a medicalprocedure.

The right side support 30 and the left side support 40 are of the sameheight so that when resting on a substantially level surface, the labslab is substantially horizontal on its top surface 20. The right sidesupport and the left side support are 7 inches in height, for example.When placed on an operating table, the lab slab 10 creates a lengthwiseaperture beneath the top planar portion and between the left and rightside supports. The height of the side supports allows clearance beneaththe top planar portion 20 for human legs to rest in the aperture withoutcontacting the underside of the table 10, or with minimal contact withthe underside of the table 10. The supports can be 6, 7, 8, 9, 10 ormore inches in height to allow leg clearance. The supports are at aheight such that when the lab slab is resting on an operating table, thetop planar portion 20 of the lab slab rests at a level between the waistheight and the elbow height of the physician or provider that isperforming a medical procedure. At this height, the provider will not beuncomfortable when reaching for the instrumentation, i.e., the providerneed not reach up above his/her mid-level for the tools.

The lab slab of FIGS. 1A-1C has a length covering from about the knee toabout the ankle of the patient over which the lab slab is placed. Thelab slab 10 may include an optional extension, shown in FIG. 1D. Theextension 50 includes side portions 52 and a top portion 54 that isslightly larger than the underlying top portion 20. The extension sideportions 52 are positioned at a width corresponding to the extension topportion 54 and slightly greater than the width of the underlying topportion 20. With such dimensions, the extension 50 is free to slide toan extended position that enlarges the available space on the top of thelab slab 10 and increase the coverage provided over the leg area of thepatient on the operating table. The extension 50 may be useful for someprocedures but not necessary in others.

Referring to FIGS. 2A and 2B, the lab slab of FIGS. 1A-1C is shown inuse over the lower legs of a patient. FIGS. 2A and 2B illustrate thatthe feet of the patient extend out of a bottom side of the lab slab. Thepatient's legs can rest easily side-by-side without discomfort. Theheight of the lab slab allows the patient to position his/her legswithout substantially contacting the lab slab.

Using the lab slab during medical procedures increases the work areawith which the provider has to work. Without the lab slab,instrumentation can become unorganized, inconveniently positioned, orharmful. Referring to FIG. 3A, instrumentation is shown placed on thelegs of a patient who is resting on an operating table for a procedure,which is a common practice. In FIG. 3B, the lab slab 10 is shown inposition over the legs of a patient. Instrumentation is placed on thetop of the lab slab in preparation for use. As is shown, the lab slab ofFIG. 3B increases the usable space available to the provider and medicalassistants. The lab slab 10 further provides protection to the patientfrom inadvertent skin punctures from sharp instruments as well as doingaway with the sensation of movement on or near the legs during aprocedure in which the patient is awake.

In FIG. 4, the lab slab is again shown in position over the lower legsof a patient lying on an operating table. Referring to FIG. 4, the labslab 10 includes radiation pads 70 positioned on each side portion ofthe lab slab. The radiation pads 70 decrease exposure to x-ray scatterso that the provider does not become overexposed to radiation usedduring the procedure. The radiation pads can include adhesive at atopside portion 72. The adhesive accomplishes connection of theradiation pad with the edge of the lab slab 10. The adhesive used on theradiation pad can be any of a number of known adhesives, such as glue,tape, VELCRO, and others. For example, the radiation pad has theattributes of the radiation pad disclosed in U.S. Pat. No. 6,310,355,entitled, “Lightweight Radiation Shield System,” assigned to WorldwideInnovations and Technologies, Inc., of Overland Park, Kans. Other knownradiation pads can be used for attachment to the table. Alternatively,the radiation pads 70 are coupled to the lab slab 10 during manufactureand are not removable (see FIGS. 6A-6C).

As shown in FIG. 4, radiation pads 70 may extend past the edge of thelab slab 10 to cover a portion of the patient. Additional protection tothe provider is thereby provided. The radiation pad 70 is a single padhaving a length greater than the length of the lab slab. The length ofthe radiation pad may be the length of the legs of the patient. Theradiation pad can fold out to a length twice as long as the length ofthe lab slab, or greater. The lab slab having radiation padsaccomplishes the dual function described above.

As shown in FIGS. 1A-1C, the lab slab can be a single molded piece ofplastic forming a horizontal surface having support members. The labslab can be constructed of substantially rigid plastic, fiberboard, orany of a number of known materials, including metals. The lab slab canbe disposable after a single use or reusable any of a number of times.

Exemplary dimensions of the lab slab are as follows. The top planarportion 20 is approximately 21 inches in width and 28 inches in length.The width of the top portion 20 is such that the top portion is slightlywider than the width of two human legs when positioned side-by-side, andslightly less wide than the width of a standard operating table, whichis approximately 2 feet in width. The right side support and the leftside support are 7 inches in height, measured from the top planar edgeof the lab slab. The lab slab 10 is manufactured of a single piece ofsubstantially rigid plastic, which is molded to include thesubstantially perpendicular right side and left side supports. Theradiation pads are approximately 28 inches in length and have a width ofat least 7 inches, but may be as wide as 8, 10, 12, or 14 inches tocover the side portion of the patient when on the operating table.

The lab slab of FIGS. 1A-1C is a single molded plastic body. Withreference to FIG. 5, an alternative embodiment of the lab slab is shown,laid out flat. The lab slab can be assembled from a flat member, makingit easy to store. In FIG. 5, the lab slab 100 includes a single bodyportion 108, side portions 112 and 114 having symmetrical folds 102 and104, tabs 108, and slots 110. Side portions 112 and 114 havesubstantially identical dimensions. The side portions 112 and 114 arefolded inward at folds 102 and 104. When folded inward, the tabs 108 onthe side portions 112 and 114 fit into slots 110. The tabs 106 securethe side portions in a perpendicular position relative to the topportion. The side portions 112 and 114 thus fold into supports for thetop portion 108, creating an instrumentation table. The top horizontalportion includes an arched bottom side 116 and a curved topside 118. Thearched bottom 116 creates additional space for a patient's feet to movewhen the lab slab 100 is in position over the patient. The shape of thetop portion 108 can, however, be any of a number of shapes, includingsquare, oval, and rectangular.

Exemplary dimensions of the lab slab 100 shown in FIG. 5 are as follows.The lab slab has a length of 16 inches. The top portion can have a widthof 20 inches. The distance from the internal fold lines (i.e., the foldlines closest to the top portion) to the external folds is 8 inches, andthe distance from the external folds to the side edge of the lab slab is8½ inches. Each tab can be 4 inches in length, and ½ inch wide. The tabsinsert into slots that are 4 inches in length. The slots are positionedtwo inches from the internal folds. Again, dimensions are exemplary onlyand not intended to be limiting.

In FIGS. 6A-6C, a lab slab is again shown in position over the lowerlegs of a patient lying on an operating table. Referring to FIG. 6A, alab slab 200 includes radiation pads 210 positioned on each side of thelab slab 200. The radiation pads 210 provide a movable outer panelrespective to the inner support which rests on the operating table. Theradiation pads 210 can be coupled to the lab slab 200 by a fold 212 atthe edge of the lab slab 200. The fold 212 allows the radiation pad 210to extend from a folded position as shown in FIG. 6A to an unfolded oropen position, shown in FIG. 6C. The fold 212 can be a hinge or otherknown coupling mechanism, for example. The radiation pad 210 can besecured in a closed position using VELCRO. Other known adhesives can beused to keep the radiation pad 210 in a closed position, i.e., close inproximity to the support side of the lab slab 200.

As shown in FIG. 6B, a provider can extend, e.g., fold out, theradiation pad 210 to an extended position for use in decreasing exposureto x-ray scatter used during a procedure. The radiation pad 210 can beunattached from the lab slab and repositioned to extend over all of or aportion of the legs of a patient. In FIG. 6C, the radiation pad 210 isfully extended and remains attached to the lab slab 200 at an edge ofthe lab slab 200. The lab slab having an attached radiation pad 210 canbe manufactured as a single molded body.

As shown in FIGS. 6A-6C, the radiation pad 210 comprises an outer panelthat is substantially the same size as the supports of the lab slab 200.The radiation pads 210 can, however, fold outward and downward such thatthe pad 210 extends below a level of the operating table.

Experimental Results

The lab slab is configured to decrease a practitioner's exposure toradiation during a procedure performed on a patient. For example, anexperimental study was conducted using fifty (50) patients undergoingleft heart catheterization, or carotid angiography. Dosimeters werepositioned at the abdomen level and at the thyroid, or neck, level ofboth the physician and scrub technologist performing the procedure.Radiation exposure was measured for the duration of a medical procedure,such as a heart procedure. A lab slab was positioned over twenty-four(24) of the 50 patients during a procedure, while twenty-six (26)patients underwent respective procedures without the lab slab. Referringto Table 1, an average weight and average body surface area of thepatients in each group was determined, and average radiation doses werecalculated for radiation measurements at the abdomen and at the neck ofthe providers. TABLE 1 AVERAGE AVERAGE AVERAGE RADIATION DOSE RADIATIONDOSE WEIGHT AVERAGE BSA AT ABDOMEN AT NECK WITH Lab Slab 91.6 kg 2.04 m20.685 mRem/min 0.27 mRem/min WITHOUT Lab Slab 97.4 kg 2.01 m2  1.49mRem/min 0.29 mRem/min

Referring to the bar graph below, experimental results of the randomizedtrial of left heart catheterization and carotid angiography show a 54%decrease in radiation exposure at the level of the abdomen of thecardiologist performing the procedure, and an 8% decrease in radiationexposure at the level of the abdomen.

The duration of both therapeutic and diagnostic procedures may varygreatly. Using the lab slab, radiation exposure is reduced during boththerapeutic or diagnostic procedures, e.g., those having a duration of 5minutes, 10 minutes, 20 minutes, 1 hour, 4 hours, 8 hours, 16 hours and24 hours. Radiation exposure can be measured and reduced for proceduresof other durations. Further, radiation exposure in a procedure isreduced by, for example, 1%, 2%, 5%, 10%, 25%, 50%, 75% and up to 100%at both the level of the abdomen and the level of the thyroid whenembodiments of the invention are used. Radiation levels measured atother locations on the physician's body are also reduced.

Other Embodiments

The embodiments of the invention described above include aninstrumentation table having two supports. Other embodiments of theinvention are acceptable, such as an instrument table having a singlesupport positioned toward a mid portion of the top plane of the table.The support allows for the legs of a patient to straddle the support,such that the left leg is on one side of the support and the right legis on an opposite side of the support. An additional acceptableembodiment includes a planar portion that rests on the legs of thepatient during a medical procedure. In addition, acceptable embodimentsof the invention include clips, slots, or apertures that hold wires andother equipment used during a medical procedure. Clips are provided atedges of the instrument table, for example, to keep the wire or wiresfrom entanglement or from getting in the way of other instrumentation.Further, in embodiments of the invention, the lab slab may include aradiation shield positioned on one side or on both sides, e.g., asextensions of one or both of the side supports of the lab slab. In stillfurther embodiments, the radiation pad can include one or more foldssuch that the radiation pad can be partially extended or fully extendedfrom a closed position proximal to the support. Also, use of the labslab can reduce radiation levels at any of a number of physicallocations of a provider, other than the abdomen and the thyroid.

Having thus described at least one illustrative embodiment of theinvention, various alterations, modifications and improvements willreadily occur to those skilled in the art. Such alterations,modifications and improvements are intended to be within the scope andspirit of the invention. Accordingly, the foregoing description is byway of example only and is not intended as limiting. The invention'slimit is defined only in the following claims and the equivalentsthereto.

1. An instrument table for placement on an operating table on which a patient rests during a medical procedure, the instrument table comprising: a planar portion having a top surface and a bottom surface, the planar portion having a width less than the width of the operating table; a first member coupled to the bottom surface of the planar portion and substantially perpendicular to the planar portion, the first member comprising: an inner panel configured to provide support to the planar portion; and an outer panel movable from a first position proximal to the inner panel and a second position distal from the inner panel, wherein the inner panel and the outer panel provide a radiation shield.
 2. The instrument table of claim 1 wherein the planar portion is extendable in length.
 3. The instrument table of claim 1 wherein the outer panel comprises a first radiation pad coupled to the inner panel.
 4. The instrument table of claim 3 wherein the outer panel is configured to fold out to the second position distal from the inner panel from an attachment point at an edge of the inner layer.
 5. The instrument table of claim 1 wherein the outer panel is extendable to a length greater than a length of the top surface of the planar portion.
 6. The instrument table of claim 5 wherein the outer panel is substantially twice the length of the top surface of the planar portion.
 7. The instrument table of claim 1 wherein the outer panel is removably attached to the inner panel.
 8. The instrument table of claim 1 wherein the outer panel extends below a surface of the operating table.
 9. The instrument table of claim 1 wherein the first member is constructed and arranged to allow clearance beneath the planar portion for human legs to rest without contacting an underside of the planar portion.
 10. The instrument table of claim 1 wherein the instrument table includes a second member coupled to the bottom of the planar portion on a side opposite the first member.
 11. The instrument table of claim 10 wherein the first side support and the second side support extend substantially perpendicularly from the planar portion to rest on the operating table straddling a portion of the legs of a patient resting on the operating table. 